cqm reports

[biller]

2012-10-05 15:23:27 PDT
I am currently using OpenEmr version 4.1.1 with the sseventh patch and running ubuntu-maverick with apache 2.2.16 php 5.3.3-1 mysql 5.1.49-1.  The problem I am having is  more with my retenskills =)  I can't seem to remember how to get the Tobacco Cessation Intervention (CQM) ( NQF:0028b ) and the Tobacco Use Assessment (CQM) ( NQF:0028a ) to show data in the CQM report.  I have entered data in the lifestyle section for smoking then I got a popup reminder that the Intervention: Tobacco was due I entered the information in there then ran the cqm report and it reports.

Tobacco Cessation Intervention (CQM) ( NQF:0028b ) 1 0 0 0 0%
Tobacco Use Assessment (CQM) ( NQF:0028a ) 1 0 0 0 0%

I had it working on a previous install so I am guessing I have just forgot to click or do something really simple.  Any help or guidance to push me in the right direction would be greatly appreciated.
Thanks in advance

John

[biller]

For whatever reason I clicked on reports/clinic/standard report and it showed up there.  It still isn't showing up under the CQM report is this normal.  What/where do I need to do to get results to show up under reports/clinic/cqm

Thanks  John

[Brady Miller]

Hi,
CQM rules generally require an encounter for the patient to include in calculation (these requirements are specific to each cqm rule, though).
-brady
OpenEMR

[biller]

Brady, thanks much for your response let me give you some extra detail and maybe you can help me get this resolved.  I logged into the openemr 4.1.1. demo site went to reports/visits/CQM ran the report saw there was a denominator of 2 for the Diabetes: HbA1c Poor Control (CQM) (PQRI:1 NQF:0059).  So I added a new patient Jane Doe with a Birthdate of  1-5-1980 then created a visit for 12-12-2012 with a procedure code of 99205 and a Diagnosis of 250.20.  I then re-ran the same report and the denominator remained at 2.  I read;

http://www.google.com/url?sa=t&rct=j&q=hemoglobin%20a1c%20poor%20control%20%2B%20openemr&source=web&cd=1&cad=rja&ved=0CEEQFjAA&url=http%3A%2F%2Fwww.open-emr.org%2Fwiki%2Fimages%2Ff%2Ff1%2F5_Measures.pdf&ei=a834UObxFsH9igLYrYDQCQ&usg=AFQjCNEU23kBm4pWYaZ6ytcQ5GQHkxWd_w&bvm=bv.41248874,d.cGE

to make sure I followed the criteria for the denominator.  Any help/guidance you could give to help me resolve this would be greatly appreciated.  Thanks  John

[Brady Miller]

Hi,

In the demo:
1. Make a new patient and ensure patient age is 17-74
2. Create an encounter
3. It doesn't check the fee sheet (which goes in the sql billing table) for diagnoses. It actually checks the diagnosis code in the Medical Problem entries from the Patient Summary screen. Note it will become obvious, because about 5 or so Clinical Reminders will pop up in the Clinical Reminders widget at the top right of the patient summary screen after you add the Medical problem.

I tested in the online demo and it worked. I'd suggest trying it again in the morning after the demo resets (the demo is sort of trashed now and acting a bit odd).

-brady
OpenEMR

[biller]

Brady, that was awesome thanks so much for the tip.  I did as you suggested ran the report and bam it showed up as the denominator.  My question now is how do I get the numerator to caculate.  I clicked on the link for due now for the A1C used the Date of Service as the completed date and tried both 9.9% as well as 3046F in the result section trying to get the numerator to calculate all to no avail.  If you would please tell me where I am off here it would be greatly appreciated.  Also so I don't keep bugging you here is there some info that I could learn from, how to calulate the denominators and numerators within OpenEMR, hopfully I can keep questions here to a minimum.  Thanks much for your help.  John

[Brady Miller]

Hi John,

There is a bit of a disconnect in the way the Standard CDR Rules and the CQM rules evaluate for the A1C. The CDR simply just checks for the existence of a A1C test via that custom input on the Clinical Reminder widget (it DOES NOT check the labs in the procedure table, which is something that should be added at some point). The CQM rules checks the value of the A1C in the labs (the procedure tables). More on setting up labs/results can be found here:
http://www.open-emr.org/wiki/index.php/OpenEMR_4.1.1_Users_Guide#Supplementary_Topics
(in the Procedure configuration & order process section)

There is CDR documentation (and a nice pdf new manual there contributed by Brad Gregg from MI2), although it doesn't go into much details on the CQM rules:
http://www.open-emr.org/wiki/index.php/CDR_User_Manual

To help guide you in the future, as an example, to figure out your diabetes rule, I looked in the following parts of the codebase:
http://github.com/openemr/openemr/blob/master/library/classes/rulesets/Cqm/reports/NFQ_0059/Numerator.php
http://github.com/openemr/openemr/blob/master/library/classes/rulesets/Cqm/reports/common/DiabetesDenominator.php
http://github.com/openemr/openemr/blob/master/library/classes/ClinicalTypes/Diagnosis.php
http://github.com/openemr/openemr/blob/master/library/classes/ClinicalTypes/codes.php

And the following doc is helpful to see the specifics of the rules (age, encounters, etc):
http://www.cms.gov/apps/ama/license.asp?file=/QualityMeasures/Downloads/EP_MeasureSpecifications.zip

-brady
OpenEMR

[biller]

Brady, Thanks much for all the links.  It took a little while to get the procedures/labs configured.  Once I did the numerator showed right up.

[Stephen Waite]

Hi. I was able to get denominator in cqm report Diabetes: HbA1c Poor Control (CQM) ( PQRI:1 NQF:0059 ) after following above steps on demo at http://demo.open-emr.org:2099/openemr/ after adding icd9 database thru external data load under administration

so it's probably the first step:

1. load icd9 database
2. create new patient aged 17-74
3. create encounter
4. add diabetes as med problem and choose appr icd 9 code
5. run report for CQM

it makes sense that the reporting engine is looking for icd 9 codes and not just the word diabetes

John (biller), what code did you use in the procedure configuration in order to get the numerator to work?

thanks